INNOVATIONS FOR TACKLING
TUBERCULOSIS IN THE
TIME OF COVID-19
PROCEEDINGS OF A WORKSHOP
Claire Biffl, Julie Liao, and Anna Nicholson, Rapporteurs
Forum on Microbial Threats
Board on Global Health
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
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This activity was supported by a contract between the National Academy of Sciences and the U.S. Agency for International Development (10004113). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-68642-6
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Digital Object Identifier: https://doi.org/10.17226/26530
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Innovations for tackling tuberculosis in the time of COVID-19: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26530.
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COMMITTEE ON INNOVATIONS FOR TACKLING TUBERCULOSIS IN THE TIME OF COVID-19: A TWO-PART WORKSHOP1
GAIL H. CASSELL (Co-Chair), Senior Lecturer on Global Health and Social Medicine, Harvard Medical School
KENNETH G. CASTRO (Co-Chair), Professor of Global Health, Epidemiology, and Infectious Diseases, Rollins School of Public Health and School of Medicine, Emory University
EMILY ABRAHAM, Director, External Affairs and Policy, Global Public Health at Johnson & Johnson
ANDREW CLEMENTS, Senior Technical Advisor, Emerging Threats Division, U.S. Agency for International Development
LUCICA DITIU, Executive Director, Stop TB Partnership, United Nations Office for Project Services
MARCOS A. ESPINAL, Director, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization
HAMIDAH HUSSAIN, Director, IRD Global
TEREZA KASAEVA, Director, Global Tuberculosis Programme, World Health Organization
KENT E. KESTER, Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur
MONIQUE K. MANSOURA, Executive Director, Global Health Security and Biotechnology, MITRE
PETER SANDS, Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria
CHARLES WELLS, Head of Therapeutics Development, Bill & Melinda Gates Medical Research Institute
National Academies Staff
JULIE LIAO, Director, Forum on Microbial Threats
ELIZABETH ASHBY, Associate Program Officer
CHARLES MINICUCCI, Research Assistant
CLAIRE BIFFL, Research Assistant
JULIE PAVLIN, Senior Board Director
__________________
1 The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.
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FORUM ON MICROBIAL THREATS1
PETER DASZAK (Chair), President, EcoHealth Alliance
KENT E. KESTER (Vice Chair), Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur
RIMA F. KHABBAZ (Vice Chair), Director, National Center for Emerging Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention
EMILY ABRAHAM, Director, External Affairs and Policy, Global Public Health at Johnson & Johnson
KEVIN ANDERSON, Senior Program Manager, Science and Technology Directorate, U.S. Department of Homeland Security
CRISTINA CASSETTI, Deputy Division Director, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases
ANDREW CLEMENTS, Senior Technical Advisor, Emerging Threats Division, U.S. Agency for International Development
SCOTT F. DOWELL, Deputy Director for Surveillance and Epidemiology, Bill & Melinda Gates Foundation
MARCOS A. ESPINAL, Director, Communicable Diseases and Environmental Determinants of Health, Pan American Health Organization
EVA HARRIS, Professor, Division of Infectious Diseases and Vaccinology; Director, Center for Global Public Health, University of California, Berkeley School of Public Health
ELIZABETH D. HERMSEN, Head, Global Antimicrobial Stewardship and Health Equity in Infectious Diseases, Merck & Co., Inc.
CHRISTOPHER R. HOUCHENS, Director, Division of Chemical, Biological, Radiological and Nuclear Countermeasures, Biomedical Advanced Research and Development Authority
CHANDY C. JOHN, Director, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine and Riley Hospital for Children at IU Health
MARK G. KORTEPETER, Vice President for Research, Professor of Preventive Medicine and Medicine, Uniformed Services University of the Health Sciences
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
MICHAEL MAIR, Acting Assistant Commissioner for Counterterrorism Policy; Acting Director, Office of the Chief Scientist, U.S. Food and Drug Administration
JONNA A. K. MAZET, Vice Provost—Grand Challenges; Chancellor’s Leadership Professor of Epidemiology & Disease Ecology, University of California, Davis
VICTORIA MCGOVERN, Senior Program Officer, Burroughs Wellcome Fund
SALLY A. MILLER, Distinguished Professor of Food, Agricultural and Environmental Sciences in Plant Pathology, The Ohio State University, College of Food, Agriculture, and Environmental Sciences
SUERIE MOON, Director of Research, Global Health Centre; Visiting Lecturer, Graduate Institute of International and Development Studies; Adjunct Lecturer, Harvard T.H. Chan School of Public Health
RAFAEL OBREGON, Country Representative, UNICEF Paraguay
KUMANAN RASANATHAN, Unit Head for Equity and Health, Department of Social Determinants of Health, World Health Organization
GARY A. ROSELLE, Executive Director, National Infectious Disease Services Program, Veterans Health Administration, U.S. Department of Veterans Affairs
PETER A. SANDS, Executive Director, The Global Fund to Fight AIDS, Tuberculosis & Malaria
THOMAS W. SCOTT, Distinguished Professor, Department of Entomology and Nematology, University of California, Davis
MATTHEW ZAHN, Deputy Health Officer, Orange County Health Care Agency
National Academies of Sciences, Engineering, and Medicine Staff
JULIE LIAO, Director, Forum on Microbial Threats
ELIZABETH ASHBY, Associate Program Officer
CHARLES MINICUCCI, Research Assistant (until September 2021)
CLAIRE BIFFL, Research Assistant
JUSTIN HAMMERBERG, Senior Program Assistant (from January 2022)
JULIE PAVLIN, Senior Board Director
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
KUNCHOK DORJEE, Johns Hopkins University
ANNA MARIA MANDALAKAS, Baylor College of Medicine
ELTONY MUGOMERI, Africa University
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of this proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by ANN M. ARVIN, Stanford University. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
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Acknowledgments
The workshop summarized in this proceedings is the product of many valuable contributions. Special thanks go to the presenters and discussants who gave generously of their time and expertise to make the event possible.
In memory of Dr. Hamidah Hussain.
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Contents
Organization of the Proceedings of the Workshop
2 CURRENT TOOLS AND CHALLENGES
Leadership from Public Health Workers in Ending Tuberculosis—Past and Present
Progress Toward Global Tuberculosis Elimination Goals and Opportunities for Moving Forward
New Technologies and Remaining Gaps in Tuberculosis Diagnostics
Improving Treatment Regimens and Vaccine Development
Collective Social Value of Infectious Disease Interventions
USAID’s Commitment to Addressing Tuberculosis Worldwide
Building a Tuberculosis-Free World: Progress Update
Realities of Multidrug-Resistant Tuberculosis
Rapid Acceleration of Diagnostics Technology: COVID-19 Pandemic Experience
Improving Adherence, Infection Control Capacities, and Cost-Effectiveness
Existing Tools and New Technologies
Transforming Treatment Options
Reflections and Discussion on Critical Elements for Implementation
5 FINANCING, AMBITION, AND PREPAREDNESS
A Place for Tuberculosis in the Pandemic Preparedness Agenda
Achieving Synergy in Global Health Security Preparedness Against Respiratory Pathogens
Boxes, Figures, and Table
BOXES
2-1 Progress in Reducing the Global Tuberculosis Burden
2-2 Challenges and Opportunities in Advancing Tuberculosis Diagnostics
3-1 Investment Priorities for Ending Tuberculosis
3-2 Point-of-Care Technologies Research Network
3-3 Research Priorities in the Cascade of Tuberculosis Prevention
4-1 Overview of Lessons Learned from TBTC Study 31/A5349
4-2 Lessons Learned from the Rollout of Bedaquiline in South Africa
4-3 Performance-Based Monitoring and Evaluation Framework: Core Indicators
FIGURES
3-1 Progress toward 2018–2022 global targets for the number of people treated for tuberculosis
Acronyms and Abbreviations
| AMR | antimicrobial resistance |
| AU | Africa University |
| BARDA | Biomedical Advanced Research and Development Authority |
| BCG | Bacillus Calmette-Guérin |
| BMGF | Bill and Melinda Gates Foundation |
| CEPI | Coalition for Epidemic Preparedness Innovations |
| CHW | community health worker |
| DALY | disability-adjusted life year |
| DARPA | Defense Advanced Research Projects Agency |
| DAT | digital adherence technology |
| DOTS | directly observed treatment, short-course |
| DR TB | drug-resistant tuberculosis |
| DS TB | drug-susceptible tuberculosis |
| ECG | electrocardiogram |
| FDA | U.S. Food and Drug Administration |
| GDP | gross domestic product |
| HIV | human immunodeficiency virus |
| HLIP | High-Level Independent Panel |
| HR | human resources |
| ICEC | International Cancer Expert Corps |
| IFI | international financial institutions |
| IGRA | interferon gamma release assay |
| IHR | International Health Regulations |
| IMF | International Monetary Fund |
| IMI | Innovative Medicines Initiative |
| IRB | institutional review board |
| IRD | Interactive Research and Development |
| J&J | Johnson and Johnson |
| LMIC | low- and middle-income country |
| MDG | Millennium Development Goal |
| MDR TB | multidrug resistant tuberculosis |
| mRNA | messenger RNA |
| NGO | nongovernmental organization |
| NHP | nonhuman primate |
| NIH | National Institutes of Health |
| PAN-TB | Project to Accelerate New Treatments for Tuberculosis |
| PCR | polymerase chain reaction |
| PEPFAR | President’s Emergency Plan for AIDS Relief |
| POC | point-of-care |
| POCTRN | Point-of-Care Technologies Research Network |
| PPR | pandemic preparedness and response |
| R&D | research and development |
| ROI | return on investment |
| RR TB | rifampicin-resistant tuberculosis |
| SDG | Sustainable Development Goal |
| TB | tuberculosis |
| TBDA | TB Drug Accelerator |
| TPT | tuberculosis preventive therapy |
| TRP | target regimen profile |
| TST | tuberculin or tuberculosis skin test |
| UHC | universal health care |
| UN | United Nations |
| UNHLM | United Nations High-Level Meeting |
| USAID | United States Agency for International Development |
| WHO | World Health Organization |
| XDR TB | extensively drug-resistant tuberculosis |
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